Fatigue among older people: A review of the research literature

Abstract

Background

Fatigue is a complex phenomenon associated with multiple antecedents and detrimental consequences. Although this symptom is prevalent in the older population, it is not easily recognized by nurses and has been under treated.

Aim

The purpose of this review is to describe the existing research on fatigue on older adults with focus on the lived experience of fatigue, factors related to such fatigue experience and the impact of fatigue on overall health.

Methods

A systematic search of the literature was undertaken to identify research evidence on fatigue among the older population. Three databases (i.e. OvidMedline, CINAHL and PsycINFO) were searched, resulting in 15 eligible studies. Three aspects about the fatigue phenomenon in older people were identified: the lived experience of fatigue, relating factors of fatigue, and impact of fatigue on overall health.

Findings

The key findings suggest that fatigue is an overwhelming experience constrains physical capacity and the energy reserve required for appropriate functioning and social participation, as well as worsens their morbidity and mortality outcomes. Yet, its heterogeneous etiologies and multi-dimensional manifestations pose a huge challenge on its diagnosis and treatment. Indeed, there was inadequate research-base evidence on fatigue management for older people. This gap in literature may imply that this problem is poorly recognized and under-treated in older people.

Conclusions

The findings highlight that fatigue is a substantial problem in older people that deserves early recognition and prompt treatment. Nurses need to be sensitive to the risk factors of fatigue in the older population and conduct a comprehensive fatigue assessment on the high risk case. Although this review only identified limited research-base evidence, the findings do give directions to the development of interventions for fatigue management for older people.

Introduction

Fatigue is a universal experience in the population and is a common symptom among older people. Epidemiology of this symptom indicated that as many as 27–50% of community-dwelling older people complain of moderate to severe levels of fatigue (Hellstrom et al., 2004, Reyes-Gibby et al., 2003, Wijeratne et al., 2007). The prevalence is even higher for those who are residing in long-term care setting (Liao and Ferrell, 2000). However, fatigue management has not received adequate attention in gerontological nursing practice. Health care interventions for ameliorating or improving this condition have been scarcely researched. Some studies have even indicated that nurses were not able to recognize this symptom among the older population (Tiesinga et al., 2002).

The inadequate attention to fatigue management among the older population may be related to the confusion surrounding the phenomenon of fatigue itself. First, diverse definitions on fatigue have been formulated, which vary considerably on the proposed causes, defining attributes, related factors and how the condition might best be alleviated (Ream and Richardson, 1996, Trendall, 2000). Second, although it is generally agreed that fatigue can have a devastating impact on overall well-being, some report in literature characterize fatigue as a protective bodily response to prevent overtaxing of functional reserve (Tiesinga et al., 1996). All of these inconsistencies may affect proper assessment of the symptoms and add difficulties to recognition and management of the condition.

Concept analysis has been conducted so as to clarify the defining concept of fatigue and to identify the phenomenon in subjects (Aaronson et al., 1999, Ream and Richardson, 1996, Tiesinga et al., 1996, Trendall, 2000). Fatigue has been identified as a subjectively reported very unpleasant experience typically described as being ‘odious’, ‘troublesome’, ‘comfortlessness’ and even ‘overwhelming’ (Ream and Richardson, 1996, Trendall, 2000). Instead of a normal response to bodily exertion, it is a sustained sense of whole body exhaustion that is disproportionate to the level of physical exertion and is not relieved by rest (Tiesinga et al., 1996, Trendall, 2000). The occurrence of fatigue involves a complex interplay of medical, physical and psychiatric factors, but can also be strikingly idiopathic. Its manifestation is multi-dimensional in nature (Ream and Richardson, 1996), and a fatigued individual may present with a lower physical capacity (Tiesinga et al., 1996, Trendall, 2000), poorer motivation to work (Aaronson et al., 1999), reduced memory, decreased attention and concentration, impaired thought processes, poorer coping ability, increased irritability and diminished social functioning (Aaronson et al., 1999, Ream and Richardson, 1996, Tiesinga et al., 1996). The overall fatigue experience is, hence, a debilitating compromise of quality of life.

The devastating consequences of fatigue are especially detrimental to older people, who have more seriously depleted reserves to make up for physical and psychological deconditioning. Inaccurate assessment, under-appreciation and under-treatment of this condition in the older population (Liao and Ferrell, 2000) suggest a need to enhance awareness and understanding of this complex and poorly defined phenomenon among nurses and other health care professionals. Indeed, as compared with the population in general, the age-related changes in functional status, co-morbidities and energy requirement may render fatigue a profoundly different experience for older people (Poluri et al., 2005). The purpose of this review is to describe the existing research on fatigue on older adults with focus on the lived experience of fatigue, factors related to such fatigue experience and the impact of fatigue on overall health. Focus was placed on the fatigue phenomenon associated with aging but not related to a specific disease.